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Say What You Mean; Mean What You Say

When I go to the doctor, I attempt to explain the problem and hope the doctor can come up with a solution. This can be challenging – partly because I don’t know which information is pertinent, and partly because neither I nor my doctor can read one another’s minds. My PCP seems to have an uncanny knack for knowing exactly which questions to ask to get the information he needs – sometimes drawing together a bizarre assortment of symptoms that I didn’t realize were related and hadn’t known to mention.

Now that I see my doctor for more than the routine “yep, you’re still healthy” checkups, I am much more interested in what takes place in the practice of medicine. From a patient’s perspective, it’s helpful to know a little more about what doctors do. One tip: they use a lot of SOAP – and not just to wash their hands. My rheumy’s EMR software is called SOAPware; my PCP’s chart notes say “S:…” “O:…” “A:…” and a second column for the P:

Subjective data reported by the patient/family

Objective data observed by the doctor on the basis of exam, tests, etc.

Assessment of all the data

Plan for treatment, additional tests, etc.

That’s the essence of what happens when we see a doctor. He gathers information (symptoms we report and signs that he observes), analyzes all the info, and comes up with a plan. He thinks.

Wouldn’t it be nice to know what the doctor would be asking? We could go to our appointments armed with specific details.

Well, to some extent we can know what the doctor is going to ask. Turns out that there are a few different mnemonics that doctors can work through to make sure they ask all the pertinent questions. SAMPLE is appropriate for EMTs; OPQRST-AAA is another mnemonic used by both EMTs and doctors; there’s also OLDCHARTS, LIQOR-AAA, OPERATES, and a host of other acronyms that can be used to help remember all the questions that should be asked. In general, they’re all looking for the same information:

Why do you need to see a doctor? This is your chief complaint – what the receptionist lists when you schedule the appointment

What are your symptoms? Be specific.

Have you noticed anything that causes the symptoms? When did it start? How often does it happen? Has this ever happened before? When does it happen? Does anything make it better or worse? For an ongoing problem, keep a calendar and show it to the doctor so he can see patterns.

How severe is the problem? How long has this been going on? Does pain awaken you or prevent you from sleeping? If you use a pain scale, be realistic.

What have you tried to treat this? What home treatments did you try? Did they help? Did you take any medication? Did it work?

As a patient, then, I need to make sure that the doctor gets accurate information. First I need to state the problem clearly. There’s a second step, though. We also need to find out what the doctor/nurse heard.

Even if we think we’re clear, we might be misunderstood. One time I fell while ice skating and suspected a broken wrist. The urgent care nurse asked, “can you move it?” and I demonstrated that movement was possible. She then wrote, “no pain on movement.” Wait a minute! “Are you capable of moving your wrist” is not the same thing as, “Does it hurt when you move your wrist?”

There was a difference between my report of symptoms and how that was interpreted. What we report is useless if we’re not heard.

I’ll get to practice this, as my daughter has an appointment with our family physician next week,
and a referral to a pediatric rheumatologist later in the month.

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One thought on “Say What You Mean; Mean What You Say”

Communication is truly an art and a skill. Loved your example of the “no pain” inference to your confirmation of being able to move your wrist. Another question health care providers often use is “Any change?” If something that was bothering you before is still bothering you, the answer “no change” is commonly inferred to mean “no problem.” When asked this, I’ll state that such and such is still a problem. What I found in my medical records, however, were simply the words “no change” with no mention of the actual problem I was still experiencing. I assumed this mentality arose because if there was a problem, the practitioner would not legally/ethically be able to go forward with performing whatever procedure I was there for. It was easier to ignore any extraneous information and surely better for business.